A case of ceftriaxone-induced haemolysis complicated by acute portal vein thrombosis

Ceffriaxone-induced immune haemolytic anemia is rare but severe complication of this type of antibiotics. In this article, we present a 43-year old patient who suffered from ceftriaxone-induced haemolysis complicated with acute portal vein thrombosis. After successful salvage and transfusion, we underwent thrombolysis via superior mesenteric artery route. Totally recanaliztion achieved. Repeated CT venography showed portal vein still patent with 6 months oral anti coagulation treatment.

Acute portal vein thrombosis in an isolated, blunt, minor liver injury near the porta hepatis

Portal vein thrombosis(PVT)secondary to blunt abdominal trauma associated with liver injury is extremely rare in healthy individuals as well as in minor liver injury,and it carries a high rate of morbidity and mortality.Moreover,acute asymptomatic PVT is difficult to diagnose.We present a young trauma patient with isolated minor liver injury associated with acute PVT.A 27-year-old man presented to the emergency department after a motor vehicle collision.His primary survey findings were unremarkable.His secondary survey showed a large contusion(7×7 cm2)at the epigastrium with marked tenderness and localized guarding.The CT angiography of the whole abdomen revealed liver injury grade 3 in hepatic segments 2/3 and 4b(according to the American Association for the Surgery of Trauma classification)extending near the porta hepatis with patent hepatic and portal veins and without other solid organ injury.The follow-up CT of the whole abdomen on post-injury day 7 showed a 1.8-cm thrombus in the left portal vein with patent right portal and hepatic veins,and a decreased size of the hepatic lacerations.A liver function test was repeated on post-injury day 4,and it revealed improved transaminitis.The patient received intravenous anticoagulant therapy with low-molecular-weight heparin according to weight-based dosing for treatment.The CT of the whole abdomen performed 2 weeks after anticoagulant therapy showed small residual thrombosis in the left portal vein.The patient received intravenous anticoagulant therapy for a total of 3 months.On the follow-up visits at 1 month,2 months,6 months,and 1 year after the injury,the patients did not have any detectable abnormal symptoms.PVT post-blunt minor liver injury is an extremely rare complication.If the thrombosis is left untreated,serious morbidity and mortality can ensue.However,its diagnosis in asymptomatic patients is still challenging.Periodic imaging is necessary for highly suspected PVT,especially in liver injury with lacerations close to the porta hepatis,even in cases of a minor injury.

Mesenteric venous thrombosis in a young adult:A case report and review of the literature

BACKGROUND Acute mesenteric vein thrombosis(MVT)accounts for only 2%–10%of all cases of acute mesenteric ischaemia,with an incidence rate of~0.1%in Europe and the United States.It represents<10%of mesenteric infarction cases and is seen predominantly in older adults.In younger individuals,MVT is uncommon,with 36%of cases having unidentified mechanisms and causes.CASE SUMMARY A 27-year-old man presented to the emergency department on February 29,2024,with a chief complaint of intermittent abdominal pain for 3 day.He was previously in good health.As the abdominal pain was not alleviated by conventional treatment,an abdominal computed tomography(CT)scan was performed,which showed increased density in the portal and mesenteric veins.Further imaging,including portal vein ultrasound,mesenteric CT angiography,and enhanced abdominal CT,revealed widespread thrombosis of the portal vein system(including the main portal vein,left and right branches,proximal mesenteric vein,and splenic vein).After 10 day of thrombectomy and anticoagulation therapy,the patient’s abdominal pain had improved significantly.Follow-up assessments indicated that portal venous blood flow had largely returned to normal.He was discharged on March 9,2024.During a follow-up exam 2 months later,repeat abdominal enhanced CT showed that the previously detected thrombi were no longer visible.CONCLUSION Clinicians should remain vigilant for acute MVT in young patients presenting with abdominal pain,to prevent misdiagnosis of this fatal condition.